Physicians, Plagues and Progress

The History of Western medicine from Antiquity to Antibiotics

Allan Chapman

• Publisher: Lion Books
• Year: 2016
• eBook ISBN: 9780745970400
• Edition: 1
• Topic: History
• Subtopic: Religion & Science
• Index: History

Since the dawn of time, man has sought to improve his health and that of his neighbour. The human race, around the world, has been on a long and complex journey, seeking to find out how our bodies work, and what heals them.

Embarking on a four-thousand-year odyssey, science historian Allan Chapman brings to life the origin and development of medicine and surgery. Writing with pace and rigorous accuracy, he investigates how we have battled against injury and disease, and provides a gripping and highly readable account of the various victories and discoveries along the way. Drawing on sources from across Europe and beyond, Chapman discusses the huge contributions to medicine made by the Greeks, the Romans, the early medieval Arabs, and above all by Western Christendom, looking at how experiment, discovery, and improving technology impact upon one another to produce progress.

This is a fascinating, insightful read, enlivened with many colourful characters and memorable stories of inspired experimenters, theatrical surgeons, student pranks, body-snatchers, 'mad-doctors', quacks, and charitable benefactors.

CHAPTER 1

Physicians, Priests, and Folk Healers

Modern medicine is rooted in science. It is based upon an understanding of the natural world in which precise observation, quantification, and internationally shared standards of experimental evidence are seen as the way forward. Over the past five centuries or so in particular, but with roots going back into the Middle Ages and beyond into classical antiquity, this approach not just to medicine, but to every realm of natural knowledge has transformed the perceptions of peoples exposed to it – from deep-space cosmology to microbiology to geology to the splitting of the atom. It bestowed a powerful cultural impulse upon Western Judeo-Christian civilization, whereby human beings have been able to transform both the environment and the human condition itself: via a progressive and science-based technology.

That science-based technology gave us everything, from medieval clockwork, via the great galleons of the Renaissance global explorers, to the steam engine, electric light, and on to mobile phones. Crucially, it gave us that capacity to alleviate not just our sufferings in the Western hemisphere, but also those of people in all places who could be reached by it: modern medicine.

That progressive medical understanding, and its ability to transform as many lives as it could reach, is the subject of this book. Yet unlike clocks or steam engines, living bodies are fiendishly complicated things, containing systems within systems, and the quest turned out to be a long one, as even modern-day medical researchers discover on a daily basis. For while we have come far, there is still a long, long way to go.

Medicine, therefore, has an ancient and a very diverse history, with many different strands coming into play over the millennia. But it was only over the last 150 years or so that medicine truly began to transform the human condition, first in the West, and then globally. So let us begin by looking at the roots of the healer’s art.

ANCIENT DOCTORS

In ancient times, medical expectations were very different from those of today. It was acknowledged that the healer’s art was much more limited than it is now, but beyond such stark practicalities, sickness itself was regarded very differently. Classical pagan, Jewish, and early Christian literature characterized disease in a wide variety of ways. There could be organic failure, such as blindness, caused by cataracts; accident, as when one fell off a speeding chariot and broke a leg; or death by poison, as in the case of snakebite. Yet even these visible maladies might be seen as the effects of deeper mysterious causes. Was one’s accident or illness the result of some sin, or failure to perform an expected ritual correctly?

When it came to overtly mysterious diseases, such as deadly epidemics, madness, or even what we would call stroke – quite literally, “to be stricken” – or heart attack, it appeared perfectly rational, within the context of ancient culture, to attribute them to some sort of divine being or group of beings. Did not human bodily afflictions derive from the same source as crop failures, lightning bolts, devastating floods, and earthquakes? In these circumstances, was it not wise to find out who had done what wrong and then perform the correct rituals, sacrifices, and prayers to your gods, rather than wasting time taking pulses or asking philosophical questions about the workings of the natural world?

Ancient literature, especially that purporting to deal with religious, philosophical, or “meaning” matters, was very much concerned with that elusive yet supremely valued state of awareness: wisdom. Socrates, as he comes over in the Dialogues of his pupil Plato, was the supreme embodiment of wisdom in classical pagan antiquity, along with the later Stoic philosophers and Roman letter-writers such as Cicero, Horace, and Seneca the Younger. And the Old Testament is full of wisdom literature: King Solomon’s Proverbs, followed by Job, Daniel, Ecclesiastes, Wisdom in the Apocrypha, and other biblical books, where wisdom is often spoken of as a serene woman who must be “sought”.

But what was “wisdom”? Generally, it was envisaged in Jewish, early Christian, pagan, and Far Eastern traditions as a “pearl beyond price” that enabled its possessor to see clearly, whereas his un-wise contemporaries saw only obfuscation. It could include the ability to set and solve riddles, to discern truth from falsehood, to interpret symbols, to know the natures of birds, animals, plants, and stones, to grasp the inner meaning of human motivations, to understand human illness, and to enjoy serenity. These were all properties conducive to a state of felicity and balance, as epitomized in the sayings and achievements of Solomon.

Wisdom, however, was essentially static, dealing with the perennial problems of the human lot, and largely inward-looking and contemplative by nature. It tended, in many ancient traditions, such as those mentioned not only in the Old Testament but also in Buddhist, Confucian, and other thought, to be of a higher value than what later ages would think of as “knowledge” or knowing the inner workings of nature from a more mechanistic viewpoint. Knowledge, or what the Greeks sometimes called technë, by contrast, was essentially outward-looking. It might be useful on an everyday basis – how to smelt iron, make wine from grapes, or splint a broken arm – but unlike wisdom, it was not especially profound. Beholding, as the Old Testament book Proverbs says, how a snake moved across a rock, or the way in which a man might try to seduce a woman, might be seen as a deep form of wisdom, yet such things were in no way related to the complex practical details of reptilian anatomy, human psychology, or neurology.¹

This manner of thinking also applied to medicine, and, in some ways, has continued to do so right down to today. One still meets highly experienced academically trained physicians of the older generation who can put together a pretty good preliminary diagnosis for a patient on little more than first acquaintance, although nowadays that diagnosis has to be backed up by subsequent scientific tests and analyses before treatment is attempted.

In the past, however, before modern tests and scans existed, all that a doctor possessed were experience, cultural sensitivity, a shrewd eye, religious and philosophical beliefs, and a high public regard based upon past successes. And the doctor, just like his patient, would approach each case with an established set of assumptions about the nature of health, disease, and well-being. Irrespective of whether that doctor was a Greek, a Jew, an Indian, an Egyptian, or even a Chinaman, he would most likely tacitly subscribe to a set of truisms about illness drawn from across the common lot of humanity. In this way of thinking, health was somehow about being in balance, and illness invariably came about when some natural bodily pathway became obstructed. That obstruction might be caused by the weather, the patient’s individual temperament, the stars, heredity, or divine or demonic agency, and it was the job of the wise physician to identify the true cause and apply the correct remedy, be it a purge, a corrective diet or fast, a prayer, or a sacrifice.

The healer, therefore, was often a versatile figure, equally at home with bowel movements, spirit divination, and advising how best to keep on the right side of the local deities. All of these options, and a good few more, were on offer in the first century AD when St Paul spoke of Luke the “beloved physician” among those who accompanied him on his apostolic journeys.

While the New Testament says nothing whatsoever about Luke’s professional activities beyond the fact that he was a doctor, we can, perhaps, risk a few guesses from writings attributed to him, namely his Gospel and the Acts of the Apostles. We know from Paul’s remarks that Luke was not Jewish but an early Gentile convert to Christianity, that he wrote good Greek, assembled materials for and presented a series of early Christian narratives in a logical and well-thought-out manner, and corresponded with a man named Theophilus: almost certainly, judging from his Greek name “Lover of God”, a fellow Greek, and probably of high social status.

One might guess from the above, therefore, that Luke was probably not a local folk-healer, but was familiar with the already widespread ideas of Hippocrates and other Greek and Latin medical writers, whose works we will examine below. These were all medical men in whose writings we see the beginnings of what might be called a scientific approach, founded upon careful observation, bodily examination, recorded case histories, and treatments based on physical criteria such as the study of lifestyle habits, food, and drug action. As a fluent Greek writer and reader, Luke would have had linguistic and cultural access to them.

None of this rational therapy would in itself exclude a belief in the miraculous, for in a world which saw the rational and the divine as intimately interpenetrating, there was no reason to think that just because a Hippocratic physician could not cure a fever, blindness, or insanity, God himself could not do so. And in his pre-Christian days, was Luke a devotee of the Greek god of healing, Asclepius? A benign deity, with his healing shrines across the pagan world, this god was instantly recognizable in art by his caduceus, or staff, around which wise serpents were entwined – the pagan patron god of pagan doctors, as Luke was destined to become a patron for Christian medical colleagues.

By the time of St Luke in the first century AD, there were already cultures familiar to any educated Greek or Roman, whose traditions already went back millennia. Some of them had been visited and written about by that redoubtable Greek tourist of the fifth century BC, Herodotus. And the country that most captivated Herodotus, about which he wrote the most in his Histories (or “Accounts”), was the already fabled and exotic land of Egypt.

MEDICINE IN EGYPT AND OTHER ANCIENT CULTURES

In the world of cultural truisms of the BC period, the mystical land of Egypt produced doctors possessing strange powers and insights. The quasi-legendary Egyptian vizier Imhotep, of c. 2700 BC, was said to have been a doctor, and wise Pharaohs and wise viziers (one of whom, in his own day a thousand years after Imhotep, would have been Joseph, of Genesis fame) gave order and health to the land of Egypt. This came about by facilitating a condition of Ma’at, meaning a state of order, peace, and well-being in the land. And the Egyptians had their own gods who could be called upon for particular medical conditions, such as the dwarf-god Bes, who assisted women in childbirth.

Part of the mystique of their medicine, however, derived from the Egyptians’ skill in embalming their dead: actually a process of dehydrating the eviscerated corpse in powdered natron (sodium carbonate and other naturally occurring sodium compounds) for 40 days, prior to applying the mummy bandages: a process mentioned in Genesis 50, following the death of Jacob, and also in Herodotus. Yet while the 1611 Authorized Version of the Genesis account of Jacob’s mummification specifies this task being performed or directed by the “physicians”, this could hardly have been the case, for the ritual evisceration involved in mummification was a low-caste occupation and not necessarily a job performed by a medical man. This mummification procedure, in which the guts, heart, brain, and other organs were removed to accompany the mummy to the tomb in separate “Canopic” jars, each of which had its protective deity, has also led to the belief that Egyptians were skilled in anatomy. In reality, however, mummification required skills that were closer to those of the ritual or sacrificial butcher than those of the physician.

Around six medical treatises of varying length survived from ancient Egypt. Most significant, and both discovered and translated in the nineteenth century, are the Ebers and Edwin Smith papyri, named after the collectors who acquired them, and now preserved in Leipzig and New York respectively.

The Ebers Papyrus, of around 1500 BC, contains a mixture of things, including several hundred primarily magical medical recipes and rituals; yet it does discuss the apparently central role played by the heart, from which a series of pipes and tubes led to all parts of the body. This must in no way be thought of as implying knowledge of the circulation of the blood: a discovery that had to wait until AD 1628. Rather, it was an early expression of a subsequently long-standing classical and post-classical concept of the heart somehow being the centre of sentience.

The Edwin Smith treatise, also from c. 1500 BC but believed to be a copy of a treatise going back perhaps to the time of Imhotep of c. 2700 BC, is, in many ways, a much more interesting document. Essentially it is a surgical work, focusing upon 48 cases of injury and indicating a remarkable sophistication both of understanding and of practical technique. The treatment of broken bones and slash and puncture wounds is described, but the most interesting section deals with head injuries, even advising how an operator might tackle gaping head wounds in which the skull is split open, revealing the meninges and brain below. It is in the Edwin Smith papyrus that the brain is first mentioned in medical history. Whoever wrote the Edwin Smith papyrus was probably a well-seasoned military surgeon who, theoretical knowledge notwithstanding, had learned in the school of practical experience how best to deal with ghastly injuries.²

Fewer explicitly medical items have survived from Babylonian and Assyrian sources, written not on papyrus-paper (not a common plant in Mesopotamia, as it was in the Nile valley), but on clay tablets. Babylonian and Assyrian tablets, however, are extremely good sources for astronomical evidence, as astrological divination was an essential part of their political culture, and their precise recording of planetary positions has been of more use to historians of astronomy than of medicine. Yet in that world, the personal health of the ruler, the political health of the kingdom, and, by extension, the wider welfare of the people were – as with Egyptian Ma’at – seen as inextricably linked, and forewarnings about them could be read in the heavens.

In Babylonian and other ancient cultures, a very significant role was ascribed to the liver: a role that survived down through the millennia into medieval European and Arab culture, and even in folk and “alternative” medicine today. I have met out-of-sorts people who described themselves as feeling liverish, and as late as the 1960s the patent medicines manufacturers advertised the contents of their tins of Andrews Liver Salts as being “for inner cleanliness” on TV commercials. It is a tasty effervescent drink with mild purgative properties.

But why the liver? I suspect that it was due to that organ’s invariable engorgement with blood when animals were butchered. Not only do Genesis and other biblical books tell us that “the life is in the blood”, but so do the writings of the Jews’ Egyptian and Mesopotamian neighbours. It is good common-sense pathology: without blood ...

Table of contents

• Cover
• Praise
• Also by Allan Chapman
• Title Page
• Copyright
• Dedication
• Contents
• List of illustrations
• Acknowledgments
• Preface
• 1. Physicians, Priests, and Folk Healers
• 2. Galen: Surgeon to the Gladiators
• 3. Arabia: The First Fruits of Medieval Medicine
• 4. Divine Light: Seeing and Perceiving in the Middle Ages
• 5. Rahere the Jester Meets St Bartholomew
• 6. Spiritual Inspiration, Miracle, Possession, Mental Illness, and the Brain
• 7. In Time of Plague
• 8. Medicine and Surgery in High Medieval Europe, 1200–1500, Part 1: Medicine and Anatomy in Europe’s Medieval Universities and Beyond
• 9. Medicine and Surgery in High Medieval Europe, 1200–1500, Part 2: Guy de Chauliac and the Great Surgery of 1363
• 10. Prince Hal and the Surgeons: The Rise of Medical Professionalism in England after 1300
• 11. Antiquity Found Wanting in Renaissance Italy: Andreas Vesalius and His Influence
• 12. William Harvey and the Circulation of the Blood
• 13. The Neurologist and the Archbishop of Canterbury, Part 1: The Oxford Experimental Club
• 14. The Neurologist and the Archbishop of Canterbury, Part 2: Brains, Minds, and Souls in Seventeenth-Century England
• 15. Breathing and Burning: Cardiology, Chemistry, and Combustion
• 16. John Wesley’s Primitive Physick and the British Priest–Physician
• 17. The Duty of Care: New Hospitals, Charities, and Medical Innovation in the Eighteenth Century
• 18. “Remember Poor Tom ’o Bedlam”: Dealing with the “Mad”
• 19. Charismatics, Quacks, and Folk Healers into the Early Industrial Age
• 20. Sewers, Soap, and Salvation: The Origins of Public Health
• 21. “Them Damn’d Murderin’ Anatomists”: The Expanding Medical Schools and the Supply of Cadavers
• 22. The Miracle of the Microscope
• 23. Chemistry and the Control of Pain: Anaesthesia and Beyond
• 24. Glasgow, 1865: Young Jimmy Greenlees Meets Professor Lister: Antiseptic Surgery and Beyond
• 25. The New Professional Healer: The Medical and Nursing Professions Take Shape
• 26. The Wonderful Century
• Appendix 1: Cataract Operation Performed by a Traditional Shaman Surgeon in a Village to the East of Agra, Northern India, c. 2010
• Appendix 2: Stents and Tents
• Notes
• Further Reading